- Design
- Meta-analysis of proportions from 11 mainly non-randomised studies
- Population
- Children having tympanostomy tube placement awake in the clinic
- Primary outcome
- Procedural success
- Effect
- 97% (95% CI 89–99%), I² 86%; parental satisfaction 95%
This meta-analysis of proportions included 11 studies of tympanostomy tube placement in awake children in the clinic, without general anaesthesia. Studies were non-randomised apart from one cross-sectional survey.
Pooled procedural success was 97% (95% CI 89–99%), though heterogeneity was high (I² = 86%). Mean FLACC pain score was 1.26 (1.10–1.45), consistent with mild discomfort, and parental satisfaction was 95% (92–97%). Adverse events were infrequent and mild, and similar in severity to those reported for operations under general anaesthesia.
For selected children this removes a general anaesthetic and a theatre slot. Success depends heavily on selection, restraint and technique, often with dedicated devices, and the studies came from units experienced in the approach. It is a reasonable option to develop, not one to try without training.
- Select children by age, cooperation, ear canal anatomy and parental preference
- Use adequate topical anaesthesia and a planned approach to positioning and restraint
- Have a clear threshold to stop and book theatre
- Audit success, pain and complications as the service starts
Why it matters
Avoiding a general anaesthetic for a short ear procedure matters to families and to theatre capacity.
Don't overread it
Non-randomised studies from experienced units — success rates reflect careful selection and may not transfer.
The statistics, in plain English
A pooled proportion of 97% with I² of 86% means the individual studies reported quite different success rates, so the pooled figure is an average of varied experience. Without randomised comparison, children chosen for office placement were likely easier cases.
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